CCDS Clinical Coding 4 — Questions and Answers
Question 1: A patient is admitted with acute-on-chronic systolic heart failure and hypertensive heart disease. Which ICD-10-CM code set correctly captures this combination?
- I11.0 and I50.21
- I50.21 and I13.0
- I11.0 and I50.9
- I13.0 and I50.21 (Correct answer)
Correct answer: I13.0 and I50.21
ICD-10-CM code I13.0 combines hypertensive heart disease with heart failure, and I50.21 specifies the acute-on-chronic systolic type, per combination code guidelines.
Question 2: Under ICD-10-PCS, which character position represents the body part in a Medical and Surgical section procedure?
- Character 3
- Character 4 (Correct answer)
- Character 5
- Character 6
Correct answer: Character 4
In ICD-10-PCS Medical and Surgical section, character 4 represents the body part involved in the procedure.
Question 3: A coder encounters a diagnosis of 'probable pneumonia' documented by the attending physician on an inpatient record. How should this be coded?
- Code only symptoms such as cough and fever
- Code the pneumonia as confirmed (Correct answer)
- Query the physician before coding anything
- Code as 'rule-out' pneumonia using a Z code
Correct answer: Code the pneumonia as confirmed
For inpatient records, UHDDS guidelines allow coding of conditions documented as 'probable' or 'suspected' as if confirmed.
Question 4: Which MS-DRG grouping concept refers to a secondary diagnosis that increases the severity of illness and resource use, elevating DRG assignment?
- Principal diagnosis
- Complication or Comorbidity (CC) (Correct answer)
- Hierarchical Condition Category (HCC)
- Present on Admission (POA) indicator
Correct answer: Complication or Comorbidity (CC)
A Complication or Comorbidity (CC) or Major CC (MCC) is a secondary diagnosis that increases DRG weight and reimbursement under the IPPS system.
Question 5: A patient undergoes a right total knee arthroplasty. The ICD-10-PCS root operation that best describes replacing the knee joint with a synthetic substitute is:
- Repair
- Reposition
- Replacement (Correct answer)
- Resection
Correct answer: Replacement
ICD-10-PCS defines 'Replacement' as putting in or on biological or synthetic material that physically takes the place of a body part.
Question 6: When a patient is admitted for chemotherapy and also has the malignancy being treated, which condition should be sequenced as the principal diagnosis?
- The malignancy
- The chemotherapy encounter (Z51.11) (Correct answer)
- The most resource-intensive condition
- The complication with the highest CC/MCC weight
Correct answer: The chemotherapy encounter (Z51.11)
Per ICD-10-CM guidelines, when admission is for chemotherapy, Z51.11 (encounter for antineoplastic chemotherapy) is sequenced as the principal diagnosis.
Question 7: A CDIS reviews a record where the physician documents 'MRSA bacteremia.' Which ICD-10-CM coding approach is correct?
- Code only A49.02 for MRSA infection
- Code B95.62 as an additional code to A41.02 (Correct answer)
- Code A41.02 for MRSA sepsis instead
- Code only the bacteremia without specifying MRSA
Correct answer: Code B95.62 as an additional code to A41.02
A41.02 captures MRSA septicemia/bacteremia; however, B95.62 is assigned as an additional code when MRSA is the causative agent in a condition classified elsewhere.
CCDS Clinical Coding 4
A patient is admitted with acute-on-chronic systolic heart failure and hypertensive heart disease.
Which ICD-10-CM code set correctly captures this combination?